Medical marijuana patients face transplant hurdles

Medical marijuana patients face transplant hurdles

By GENE JOHNSON – 9 hours ago

SEATTLE (AP) — Timothy Garon's face and arms are hauntingly skeletal, but
the fluid building up in his abdomen makes the 56-year-old musician look
eight months pregnant.

His liver, ravaged by hepatitis C, is failing. Without a new one, his
doctors tell him, he will be dead in days.

But Garon's been refused a spot on the transplant list, largely because he
has used marijuana, even though it was legally approved for medical reasons.

"I'm not angry, I'm not mad, I'm just confused," said Garon, lying in his
hospital bed a few minutes after a doctor told him the hospital transplant
committee's decision Thursday.

With the scarcity of donated organs, transplant committees like the one at
the University of Washington Medical Center use tough standards, including
whether the candidate has other serious health problems or is likely to
drink or do drugs.

And with cases like Garon's, they also have to consider — as a dozen states
now have medical marijuana laws — if using dope with a doctor's blessing
should be held against a dying patient in need of a transplant.

Most transplant centers struggle with the how to deal with people who have
used marijuana, said Dr. Robert Sade, director of the Institute of Human
Values in Health Care at the Medical University of South Carolina.

"Marijuana, unlike alcohol, has no direct effect on the liver. It is however
a concern ... in that it's a potential indicator of an addictive
personality," Sade said.

The Virginia-based United Network for Organ Sharing, which oversees the
nation's transplant system, leaves it to individual hospitals to develop
criteria for transplant candidates.

At some, people who use "illicit substances" — including medical marijuana,
even in states that allow it — are automatically rejected. At others, such
as the UCLA Medical Center, patients are given a chance to reapply if they
stay clean for six months. Marijuana is illegal under federal law.

Garon believes he got hepatitis by sharing needles with "speed freaks" as a
teenager. In recent years, he said, pot has been the only drug he's used. In
December, he was arrested for growing marijuana.

Garon, who has been hospitalized or in hospice care for two months straight,
said he turned to the university hospital after Seattle's Harborview Medical
Center told him he needed six months of abstinence.

The university also denied him, but said it would reconsider if he enrolled
in a 60-day drug-treatment program. This week, at the urging of Garon's
lawyer, the university's transplant team reconsidered anyway, but it stuck
to its decision.

Dr. Brad Roter, the Seattle physician who authorized Garon's pot use for
nausea, abdominal pain and to stimulate his appetite, said he did not know
it would be such a hurdle if Garon were to need a transplant.

That's typically the case, said Peggy Stewart, a clinical social worker on
the liver transplant team at UCLA who has researched the issue. "There needs
to be some kind of national eligibility criteria," she said.

The patients "are trusting their physician to do the right thing. The
physician prescribes marijuana, they take the marijuana, and they are
shocked that this is now the end result," she said.

No one tracks how many patients are denied transplants over medical
marijuana use.

Pro-marijuana groups have cited a handful of cases, including at least two
patient deaths, in Oregon and California, since the mid-to-late 1990s, when
states began adopting medical marijuana laws.

Many doctors agree that using marijuana — smoking it, especially — is out of
the question post-transplant.

The drugs patients take to help their bodies accept a new organ increase the
risk of aspergillosis, a frequently fatal infection caused by a common mold
found in marijuana and tobacco.

But there's little information on whether using marijuana is a problem
before the transplant, said Dr. Emily Blumberg, an infectious disease
specialist who works with transplant patients at the University of
Pennsylvania Hospital.

Further complicating matters, Blumberg said, is that some insurers require
proof of abstinence, such as drug tests, before they'll agree to pay for
transplants.

Dr. Jorge Reyes, a liver transplant surgeon at the UW Medical Center, said
that while medical marijuana use isn't in itself a sign of substance abuse,
it must be evaluated in the context of each patient.

"The concern is that patients who have been using it will not be able to
stop," Reyes said.

Dale Gieringer, state coordinator for the California chapter of NORML, the
National Organization for the Reform of Marijuana Laws, scoffed at that
notion.

"Everyone agrees that marijuana is the least habit-forming of all the
recreational drugs, including alcohol," Gieringer said. "And unlike a lot of
prescription medications, it's nontoxic to the liver."

Reyes and other UW officials declined to discuss Garon's case.

But Reyes said that in addition to medical concerns, transplant committees —
which often include surgeons, social workers, and nutritionists — must
evaluate whether patients have the support and psychiatric health to cope
with a complex post-operative regimen for the rest of their lives.

Garon, the lead singer for Nearly Dan, a Steely Dan cover-band, remains
charged with manufacturing weed. He insists he was following the state law,
which limits patients to a "60-day supply" but doesn't define that amount.

"He's just a fantastic musician, and he's a great guy," said his girlfriend,
Leisa Bueno. "I wish there was something we could do legally. ... I'm going
to miss him terribly if he passes."

On the Net:

United Nework for Organ Sharing: http://www.unos.org

Garon performing his song "Goodbye Baby":
http://www.youtube.com/watch?vUJDihYn_fJA

http://ap.google.com/article/ALeqM5h3B3x4_UQedX-vvWm3cQMTXI_d1gD909OP700